Single incision laparoscopy cholecystectomy in patients with empyema of the gallbladder

Background
Laparoscopic cholecystectomy is considered to be the gold standard in treatment of gallstones. Single incision laparoscopic cholecystectomy is gaining in popularity because of the appealing cosmetic results.

Method
We retrospectively reviewed 274 cases that presented with acute cholecystitis and were treated laparoscopically using a single umbilical incision. All operations were performed by the same surgical team and the umbilicus was the only point of entry for all patients. All data and demographics on these patients were gathered and analyzed.

Results
Of the 274 cases which were treated with single incision laparoscopic cholecystectomy, 16 were found to have empyema of the gallbladder with extensive gallbladder wall thickening. 5 cases from the 16 were converted to either open cholecystectomy or the classic 4 port technique. Of the remaining 11 cases, 9 completed the laparoscopic procedure using the initial single umbilical incision. Two cases had their gallbladders partially removed because of the extensive gallbladder wall thickening, leaving intact the posterior gallbladder wall which was thoroughly cauterized. The average procedure time was 140 minutes in these 9 cases. There were no post operative complications and the average hospital stay was 3.4 days.

Conclusion
Single incision laparoscopic cholecystectomy can be performed on patients who present with empyema of the gallbladder. Although the procedure may be demanding and time consuming as compared to the classic 4 port laparoscopic technique, the procedure is safe in surgeons with advanced laparoscopic training.